Tracer methodology, used by The Joint Commission since 2004, has increased the focus on the patient care process at the point of care.
"During many surveys, the frontline staff nurse becomes one of the most critical players in not only the tracer process but in the survey itself," says Jodi Eisenberg, MHA, CPMSM, CPHQ, CSHA, program manager of accreditation and clinical compliance at Northwestern Memorial Hospital in Chicago. Eisenberg is a columnist and advisor to Briefings on The Joint Commission. "To me, that makes sense. Who spends the most time with our patients? The frontline staff nurse."
This can be a major advantage in that the surveyors are tracing the actual services and care that patients receive. The surveyors have an opportunity to observe care in various locations depending on the complexity of the patients, their length of stay, and the services they received.
Tracer methodology allows surveyors to determine whether there is consistent provision of appropriate and safe access to care, treatment, and services. By viewing care across the organization, it allows the surveyors to validate consistency, safety, and uniform performance of care, treatment, and services. Last, the tracer process provides a view of communication throughout the continuum of care and at discharge and/or transfer to another level of care, whether that is to home or to another type of facility.
"We all have access to some traditional tracer tools, which map out the elements of performance that we find in the standards," says Eisenberg. "The focus of these tools is on general admission, assessment, treatment, reassessment, documentation, education, staff competency, and other areas."
Tracers can be built around the priority focus areas. Clinical service groups can also be targeted as those highlight the types and categories of patients.
Some universal tracer tips for those running the tracers are:
- Involve as many people as possible
- "Act the part. Be the surveyor."
- Ask staff to show you data, policies, and/or procedures
- Focus on staff members and not management
- Ask open-ended questions
- Teach as you go
- Hold staff members and management accountable–but don't forget to reward and acknowledge good compliance
- Use findings to reinforce good practice
- Take good notes
- Summarize the findings
- Provide feedback